Healthcare Provider Details

I. General information

NPI: 1760894612
Provider Name (Legal Business Name): JESSICA DANIELLE ADAMS LCPC; LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 09/09/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E MAIN ST STE 205
MEDFORD OR
97501-6047
US

IV. Provider business mailing address

808 N KEENE WAY DR
MEDFORD OR
97504-6513
US

V. Phone/Fax

Practice location:
  • Phone: 208-344-5440
  • Fax:
Mailing address:
  • Phone: 208-344-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5806
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC8237
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: